Nuclear Medicine Procedures made easy

1. LUNG PERFUSION
BY
DR. ASHRAF ANAS ZYTOON MD, PHD, FJRS
MENOUFIYA UNIVERSITY - EGYPT
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2. Radiopharmacy
Radionuclide
• 99mTc
• T1/2: 6 hours
• Energies: 140 keV
• Type: γ, generator
Radiopharmaceutical
• MAA (macroaggregated albumin) or HAM (human
albumin microspheres)
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3. Adult Dose Range
• 2–6 mCi (74–222 MBq)
Method of Administration
• Before injection, the patient should cough and take
several deep breaths.
• Intravenous (IV) injection.
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4. 4

5. Indications
• Evaluation for pulmonary embolism (PE).
• Evaluation of pulmonary perfusion.
• Evaluation of chest pain.
• Evaluation of shortness of breath.
• Evaluation of lungs for pre- and post-lung surgery.
Contraindications
• Should not be performed on patients with
pulmonary hypertension.
• Active pneumonia.
• Hypersensitivity to human serum albumin.
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6. Patient Preparation
• Identify the patient. Verify doctor's order. Explain
the procedure.
• Obtain a recent (within 24 hours) chest x-ray.
Equipment
Camera
• Large field of view
Collimator
• Low energy, all purpose, or low energy, high
resolution
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7. Procedure
• (Time: ~15–30 Minutes)
• Images (typically): anterior, RAO, RLAT, RPO,
posterior, LPO, LLAT, and LAO.
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8. Lung Ventilation
(Usually Performed
with Lung Perfusion)
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9. Radiopharmacy
Radionuclide
133Xe
• t1/2: 5.3 days
Energies: 81 keV
Type: β-, γ
99mTc
• t1/2: 6 hours
Energies: 140 keV
Type: γ, generator
Radiopharmaceutical
• 133Xe:gas
• 99mTc-DTPA (diethylenetriaminepentaacetic acid)
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10. Localization
• Compartmental by inhalation into lung space.
Adult Dose Range
• 133Xe:10–20 mCi (370–740 MBq); Tb = ~30 seconds.
• 99mTc-DTPA: 25–40 mCi (925–1480 MBq); T = >1
b
hour.
Method of Administration
• Inhalation through mask or mouth apparatus.
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12. Indications
• Evaluation and detection of pulmonary embolism
(PE) in conjunction with lung perfusion
(mismatching defects).
• Evaluation of chronic obstructive pulmonary
disease (COPD) in conjunction with lung perfusion
(matching defects).
• Evaluation of shortness of breath.
• Evaluation of chest pain.
Contraindications
• Active pneumonia.
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13. Patient Preparation
• Identify the patient. Verify doctor's order. Explain
the procedure.
• Obtain recent (within 24 hours) chest X-ray.
Equipment
Collimator
• 133Xe: Low energy, all purpose, or low energy, high
sensitivity
• 99mTc-DTPA: Low energy, all purpose, or low
energy, high resolution
Procedure
(Time: ~15–30 Minutes) 13

14. Dacryoscintigraphy
(Lacrimal Study)
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15. Radiopharmacy
Radionuclide
• 99mTc
• t1/2: 6 hours
• Energies: 140 KeV
• Type: γ, generator
Radiopharmaceutical
• Na 99mTcO4- (Pertechnetate)
Localization
• Passive transport, following path of tears in
nasolacrimal system from eye to nose. 15

16. Adult Dose Range
• 50–200 uCi (1.85–7.4 MBq).
Method of Administration
• Application of drops using eye-dropper to one or
both eyes.
Indications
• Assessment of lacrimal duct patency.
• Localization of functional nasolacrimal duct
obstruction.
• Assessment of epiphora (pathological watering of
eyes).
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17. Equipment
Collimator
• Low Energy, All Purpose or Low Energy, High
Resolution, pinhole if available with 1-mm or 2-mm
insert.
Computer Set-up
Flow
• 1–5 seconds/frame for 5 minutes.
Dynamic
• Obtain immediate image and, one image every 5
minutes up to 30 minutes, then every 10 minutes
up to 60 minutes post application.
Procedure
Apply 1 to 10 drops per eye
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